New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
9/23/2025 3:02:00 PM
Cost:
150
Service:
Frame + Lenses
prescribed by doctor:
Dr. Elias Jrady
Notes:
Metal Frame + US Design PRO + Transition + Montage IDOL
SPH
CYL
AX
ADD
OD
-2
2
90
1.5
OS
-2
1.75
105
1.5
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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